Monday, July 29, 2013

Psychoeducational Intervention in Fibromyalgia

Recently I’ve read a study and had to think quite a lot. So I’d like to share my thoughts on this study.

J.V. Luciano and colleagues published a study: “Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care: An Economic Evaluation Alongside a 12-Month Randomized Controlled Trial.” They concluded: “Our findings demonstrate the long-term clinical effectiveness of a psychoeducational treatment program for FM implemented at primary care level and the cost-utility from a health care and societal perspective.”

If we look at the study, I have my doubts about the validity of these conclusions. The intervention is described as: “The educative part of the program (5 sessions) included information about typical symptoms, usual course, comorbid medical conditions, potential causes of the illness, the influence of psychosocial factors on pain, current pharmacological and nonpharmacological treatments, the benefits of regular exercise, and the typical barriers to behavior change.” “The autogenic training (4 sessions) was led by a clinical psychologist with the main aim of increasing participants’ pain control.“ Four session of autogenic training hardly have an impact. It is less easily acquired than the progressive relaxation technique by Jacobson. It has to be trained regularly. Even if the “psychologist emphasized the need to practice the relaxation techniques at home daily“, we don’t know if the patients did so. With educational programs you aim at knowledge transfer, which these programs fulfil. One hopes for behavioural changes, but the training of these changes aren’t implemented in such programs.

Now let’s look at the results. Only 21 out of 108 patients received all nine sessions. How can you calculate anything in the intervention group, if you have: “Received zero sessions, n= 10”? And how do you calculate if at 12 months only 86 patients remain in the non-intervention group?

The study seems to tell that educational programs are cost effective. I also think that they are, but this study cannot prove it because of not defining beforehand how much non-adherence to the protocol is feasible. The statistical calculations lack a firm basis.

I think any effective multimodal approach to treating fibromyalgia needs an educational program as a basis, but the core should be a behavioural training to reverse the path of fibromyalgia.

J.V. Luciano and colleagues:  

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